Anxiety


(a) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

(b) The person finds it difficult to control the worry

(c) The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children

 1. Restlessness or feeling keyed up or on edge

 2. Being easily fatigued

 3. Difficulty concentrating or mind going blank

 4. With irritability

 5. Muscle tension

 6. Sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep)

(d) The focus of the anxiety and worry is not confined to features of an axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder

(e) The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

(f) The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder



It is important to note that the diagnosis of GAD does not apply when the clinical picture can better be attributed to another diagnosis or when the clinical picture can be attributed to a medical condition, substance use, or substance withdrawal [1].

People with GAD have excessive anxiety about typical, everyday situations [1]. These patients may have a range of complaints including, but not limited to, sleep disturbances, restlessness, muscular tension, gastrointestinal complaints, and chronic headaches.

Panic disorder is defined as recurrent, unexpected panic attacks for more than 1 month in association with at least one of the following symptoms: persistent concern about having additional attacks, worry about the attacks’ implications and/or consequences, or a significant change in behavior as a result of the attacks [4]. At least one comorbid axis I disorder, such as major depressive disorder or another anxiety disorder, is commonly associated with panic disorder [5]. In addition, panic disorder is associated with low education and relatively low probability of working full time [5].

It is thought that anxiety is often a learned response to noxious or aversive stimuli [2]. Patients suffering from an anxiety disorder are more likely to have other medical issues, have longer hospital stays, undergo more procedures, incur higher health-care costs, suffer from failure at school or work, have lower-paying jobs, and are more often financially dependent on welfare [2]. In addition, anxiety disorders are the most prevalent mental disorder among American children and adolescents [3].

Identification of generalized anxiety disorder is of special importance to clinicians in both the emergent and non-emergent settings, because misdiagnosis can lead to costly, invasive, and/or harmful unnecessary medical testing.



26.2 Risk Factors for Anxiety






  • A genetic component plays a role in anxiety disorders.



    • The greatest association is in panic disorder, generalized anxiety disorder, and phobias.


  • Having involved, controlling, and rejecting parents


  • Female


  • Low education


  • Low socioeconomic status


  • Social disability


  • Family history of anxiety disorders


  • Introverted personality in early childhood


  • Traumatic life events


  • Sleep disturbances


  • Poor physical health


26.3 Differential Diagnosis


Anxiety is a diagnosis of exclusion. A thorough medical evaluation is needed to both rule out and alleviate the patient’s concern for serious medical conditions.



  • Medication side effects



    • Beta agonists


    • Caffeine


    • Digoxin toxicity


    • Levodopa


    • Nicotinic acid


    • SSRIs


    • Steroids


    • Stimulants


    • Theophylline


    • Synthetic thyroid hormone


  • Cardiovascular



    • Acute coronary syndrome


    • Congestive heart failure


    • Mitral valve prolapse


    • Dysrhythmias


    • Syncope


    • Hypertension


  • Pulmonary



    • Asthma


    • Chronic obstructive pulmonary disease


    • Hyperventilation


    • Pneumonia


    • Pneumothorax


    • Pulmonary edema


    • Pulmonary embolus


  • Endocrine



    • Hyperthyroidism


    • Hypothyroidism


    • Hyperadrenalism


  • Gastrointestinal



    • Gastroesophageal reflux disease


    • Irritable bowel syndrome


    • Colitis



      • Typically of a chronic nature


    • Ulcers


  • Neoplastic



    • Carcinoid syndrome


    • Pheochromocytoma


    • Insulinoma


  • Neurologic



    • Parkinsonism


    • Encephalopathy


    • Restless leg syndrome


    • Seizure


    • Vertigo


    • Brain tumor


  • Psychiatric



    • Affective disorders


    • Depression


    • Drug abuse


    • Drug dependence


    • Drug withdrawal



      • Both illicit and prescribed


  • Other conditions


  • Anaphylaxis


  • Anemia


  • Typically chronic


  • Electrolyte abnormalities


  • Occurring over time


  • Porphyria


  • Menopause


26.4 Types of Anxiety Disorders [2]




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Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Anxiety

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